Provider Demographics
NPI:1215921788
Name:PATEL, JAYANTILAL K (MD)
Entity type:Individual
Prefix:DR
First Name:JAYANTILAL
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAYANTILAL
Other - Middle Name:K
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:123 SINGERLY AVE
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5523
Mailing Address - Country:US
Mailing Address - Phone:410-398-3434
Mailing Address - Fax:
Practice Address - Street 1:123 SINGERLY AVE
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5523
Practice Address - Country:US
Practice Address - Phone:410-398-3434
Practice Address - Fax:410-398-3070
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0022307207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD189011500Medicaid
MD6574JKMedicare ID - Type Unspecified
MD189011500Medicaid